Provider Demographics
NPI:1932750080
Name:GREENWOOD, MCKENZIE BLAKE (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:BLAKE
Last Name:GREENWOOD
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 W BROOKS ST
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73019-1018
Mailing Address - Country:US
Mailing Address - Phone:405-659-7754
Mailing Address - Fax:405-325-8388
Practice Address - Street 1:180 W BROOKS ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73019-1018
Practice Address - Country:US
Practice Address - Phone:405-659-7754
Practice Address - Fax:405-325-8388
Is Sole Proprietor?:No
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10572255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer